In the US, many mothers who have “no indicated risk” for a difficult vaginal birth are having caesarean deliveries - and the rate is rising year by year - according to a report in the British Medical Journal.

“It’s clearly a significant trend, accounting for about a quarter of the increase seen in the last 6 years in the primary caesarean rate,” lead author Dr. Eugene Declercq, of Boston University School of Public Health, told AMN Health.

Declercq and colleagues at the National Center for Health Statistics in Hyattsville, Maryland, analyzed data from approximately 4 million birth certificates annually between 1991 and 2001.

They found that the rate of caesareans among low-risk mothers increased every year, from 3.3 percent in 1991 to 5.5 percent in 2001.

The rate was highest in older, first-time mothers, such that 19.5 percent of those over age 34 had an apparently unnecessary caesarean in 2001.

“There is speculation that mothers who perceive themselves as having their last birth may have a caesarean,” Declercq said. “Another element may be the perception of age in and of itself as being a risk factor, although the evidence for that is not clear.”

He added, “Caesareans are wonderful when they’re necessary ... The question that arises is the degree to which they’re appropriate when there is no medical indication.”

SOURCE: British Medical Journal, November 20, 2004.